Hair Loss on GLP-1s: What You Need to Know

Noticing hair shedding after starting a GLP-1? This episode explains why rapid weight loss can trigger telogen effluvium, how to tell temporary shedding from pattern thinning, and what timelines are normal. We break down what’s known about semaglutide and tirzepatide and how dermatologists evaluate hair changes.

You’ll learn when to wait, when to treat, and which options—like labs, minoxidil, or other therapies—may help. GLP-1s offer big health benefits, and with the right plan, your hair doesn’t have to be the tradeoff.

Transcript

Welcome And Topic Setup

SPEAKER_01 0:00

Is there anything we can do from the get-go to reduce the chance of people getting shedding? Evolution to androgenetic hair loss, whereby one part of the scalp is thinning much more than another. But you're not making your hair worse by shampooing every day. The hair that's going to come out is the hair that's going to come out. What recommendations do we have to patients going through a shed? You know, I think the first thing I say to patients is absolutely my very first thought is, I wonder if this patient is developing some androgenetic hair loss.

SPEAKER_00 0:35

Welcome to Dermot Trotter, Don't Swear About Skin Care, where host Dr. Shannon C. Trotter, a board-certified dermatologist, sits down with fellow dermatologists and skincare experts to separate fact from fiction and simplify skincare. Let's get started.

SPEAKER_02 0:52

Welcome to the Dermotrotter, Don't Swear About Skin Care podcast. Today's episode, I've got Dr. Jeffrey Donovan, who's a dermatologist that specializes in guess what? Hair loss. That's all he does. And for you listeners out there, you need to realize dermatologists, we manage hair loss. Now, Jeff practices in British Columbia, Canada, and he's currently the president of the Canadian Hair Loss Foundation. So definitely a der guru in the field of hair loss. So welcome to the podcast, Jeff. It's great to have you here.

unknown 1:21

Dr.

SPEAKER_01 1:21

Trotter, thanks so much. It's uh really wonderful to be covering this topic, and I'm looking forward to it.

How Common Is GLP-1 Hair Loss

SPEAKER_02 1:26

Well, I followed you, and everything you do obviously is centered around hair loss. And a hot topic for our patients nowadays, and I think even for dermatologists in dealing with this, is hair loss surrounding GLP1s and just how prevalent they've become. And people really scared maybe to even go on them, knowing that weight loss might be a benefit that can motivate us to do a lot of scary things. But I think when people see hair loss as a side effect, it does make them pause. So I was gonna have you kind of just take us back to kind of GLP1s, how they've kind of entered, you know, into our realm and dermatology and talk about why do we even see hair loss with GLP1s?

SPEAKER_01 2:02

Isn't it incredible? I mean, these medications have really taken over the dialogue in terms of the common, common words that we're familiar with now that we weren't five years ago. But, you know, I think an important theme today is we don't understand all of the facts. We certainly understand a lot, but we don't understand everything. We know that maybe 10 or 15% of people that use these medications are going to get hair loss, but not everybody does. And so I think that's really important to be aware of that there's a good proportion of people that can use these medications successfully to, you know, lose weight or manage diabetes and not experience hair loss. So it's not everyone, but it probably is around 15% of people that are going to get this. But we don't understand it all. Is it because the weight loss itself is causing the hair loss? That's the current theory that if you lose weight faster, you're gonna get more hair loss. If you have more dramatic weight loss, you're gonna have more dramatic hair loss odds. But we don't understand it all yet.

Weight Loss Speed, Mechanisms, And Unknowns

SPEAKER_02 3:09

You probably reassured some people out there because I think just because it's so buzzy, you know, people are hearing about it, they're probably thinking, oh, like 80% of people, 90% get hair loss. And if you're saying, you know, probably around 15% get hair loss, you know, then I told people, well, look at the flip side, right? 85% of people probably will not get hair loss. And I think that's really interesting, you know, from the standpoint of the why. Because if, you know, you would think if it was related to the weight loss itself and how rapid that can happen with a lot of patients on GLP1s, although we're titrating them to maybe help it be a little slower for people. But it is kind of interesting then mechanistically, the why. So I think more will probably come on that research and how it's really affecting the hair follicle, or maybe people are genetically susceptible or other things going on. What about, you know, some of the other side effects, I guess, that you might associate with GLP1s? Like if somebody has nutritional issues or deficiencies linked to it, do you think those types of things play a role too into the hair loss? Or when you've evaluated people with GLP1 related hair loss, are those not that common?

Nutrient Labs And Prevention Questions

SPEAKER_01 4:09

I think they're probably really relevant. And when I see patients with hair loss from GLP1s, I really want to make sure that iron is okay, B12 is okay, vitamin D is okay, zinc is okay. These are the four main ones. And, you know, if there are any deficiencies, then certainly we want to supplement. I think a key question for the future is is there anything we can do from the get-go to reduce the chance of people getting shedding? Can we supplement generously with some of these things? Does that make any difference? Does the speed of hair loss make any difference? Does supplementing with collagen or excess protein, is this the way to go? And you know, I think on the internet it seems much more clear. Of course, you should be doing that. I don't you know this? You should be taking hundred grams of protein and you should be doing this. The reality is we don't know. Um, but those are the four main things that I check for. Um, and sometimes they're low and sometimes they're not. But I think that if you're going into um starting a GLP one and you already have some kind of micronutrient deficiencies, you know, it's possible you're setting yourself up for some greater odds of uh of hair loss.

SPEAKER_02 5:28

That makes sense. And I think the prevention part would probably make people feel better about it. I I had a patient come in and she actually goes to a weight loss clinic ran by a plastic surgery group, and she told me right off the bat they were recommending nutritional supplementation, you know, although she said there's no evidence they really told me it might help, but they said, you know, I could experience hair loss. So they just thought, let's try this. And I said, well, that's part of the key. We really don't know if they haven't checked values on you. And just like you mentioned, same labs that I checked on her, and they were all fine. So, you know, I told her, you know, I really don't know that this is going to change the likelihood of you having it, but still the odds are in your favor that you may not experience it. What about the different GLP ones, though? I think that's a question a lot of people are wondering, you know, if I'm going to be put on semaglutide or trzepatide. Do we have any evidence in doing some of these reviews? Does the actual medication make a difference in the likelihood of you having hair loss or they kind of all approach similarly, or we just don't know yet?

Drug Differences And Emerging Patterns

SPEAKER_01 6:25

We really don't know yet. We have the most data for semaglutide and trzepatide. And so because we have the most data on it, it that those are the the two that rise to the top. But, you know, we just don't have as much data for some of the others. And the thing that's so important about these GLPs is they're so different. And from what I hear, there's going to be even more GLPs coming out. There's going to be so many on the market in the next 10 years that we won't even we won't even know what the names are. And so I think that's really important because they probably do act slightly differently. Um, and the thing that we're learning now is that, you know, maybe just maybe some of these GLPs cause not only an increased risk of shedding, but maybe just maybe they push along the chance to develop genetic hair loss or androgenetic thinning. And so I think that's a really, really important finding in the last 12 months is that now, as dermatologists, we have to have in our mind the concept of shedding or telogen afluvium, but I think we also have to have in mind the possibility that it pushes along genetic hair loss. And that's that's a big deal because I think that changes the conversation.

Shedding Versus Androgenetic Thinning

SPEAKER_02 7:41

I think some people just probably spit out their water, their coffee, or wine or whatever they were drinking when you just said that. Because I think again, where people are looking at these medications, and I think it's the way we've sort of portrayed them, you know, in the medical community, I think also online that they are sort of the new, if you will, saving grace of just their impact, yes, on weight. You know, we can have weight loss with them, weight reduction, improvement in diabetes, cardiovascular disease. And then of course they're being studied for a myriad of other things too, and the potential benefits. You know, I think a lot of people, you know, the hair loss piece, even if it is, you know, 15%, that can make people hesitate. And if we could show some variations maybe in the type of GLP1 or your likelihood, I think that could actually balance that argument. But I think for people that are genetically susceptible, that'd be very interesting. Like, how do you pinpoint who those people are? Because that is one of the greatest fears, I think, of a lot of people, you know, just the significance of hair, the cultural and social and emotional impact our hair has for us, you know, to think like, great, I'm gonna get healthy in other ways, but would I be willing to do it at the expense of losing my hair? And I know there's a lot of my patients that would probably say, no, I don't think so. But like you mentioned, there might be ways we could sort of balance that or combat that. I was gonna have you just dive a little deeper, you know, kind of explaining the telogen effluvium a little bit more because I do feel like patients like, what does that really mean? You know, just to have shedding? And with GLP ones in general, if that happens, does it tend to get better over time, or is some people have it more of a chronic fashion if they're on the medication long term, which is ultimately the goal I know for a lot of patients?

Timeline Of Telogen Effluvium

SPEAKER_01 9:09

Yeah. So a telogen effluvium is a process where the hair sheds whenever it feels that there's been some kind of stress. And so we know telogen effluvium happens from uh when you have low iron or thyroid disease, or you start some medications. And so sometimes the body interprets the weight loss that is occurring as being a stress. And so often patients will get shedding, if they are so susceptible, about two months after starting these GLP ones. Now, most people will continue to shed, if they're a shedder, until the weight stabilizes. But then once the weight stabilizes, the vast majority of patients will return to normal shedding patterns and normal density again. And I think as dermatologists, that's the tightly knit story we want to have: that you shed, and then when your weight is stable, you stop shedding. The reality is that some patients follow that story, but not everyone does. And so some people will continue to shed, it's a small proportion. And then some people will say, Hey, it's been seven months of being stable on this weight, and I didn't get my hair back yet. When is it coming back? Those are the people that are probably having their androgenetic hair loss arriving on scene or being pushed along. But the vast majority of patients will stop shedding and a lot of them will get their hair back. It's just we don't know what to do with the people that don't fall in that category yet.

Managing Ongoing Shedding And Recovery

SPEAKER_02 10:44

And I think that's the scary part for those folks because you know, I it is unpredictable, right? Who's going to be in that category? So I'm kind of excited as we learn a little bit more and studying kind of you know where this happens. So, you know, I think too, if if somebody does come in to your clinic and they were put on a GLP one for whatever reason, because now I even understand we're looking at these for other forms of hair loss that they might even be beneficial, which is something I'll probably have you touch on because I think that's you know also the opposite of probably what a lot of people are thinking out there, since the focus has been so much on them causing hair loss, obviously. But if, you know, for people that you know come in and they're experiencing it, beyond, I know we talked about maybe checking some lab work, are there other recommendations that you have that you can approach, you know, to treat it while they're going through that shed phase, if you will, or maybe even if you think they're approaching androgenetic or female or male pattern loss as well.

Clinic Approach And Treatment Pathways

SPEAKER_01 11:35

Yeah. And I think that, you know, certainly if patients are having evidence of uh evolution to androgenetic hair loss, whereby one part of the scalp is thinning much more than another. Perhaps the back of the scalp is thick, but it's the top that's really dramatically changing. If there's hairs that are getting thinner, and we call that miniaturization, if there's miniaturization that's cur occurring, then it's possible that you do have androgenetic alopecia that's part of the scene now. And androgenetic alopecia is not reversible to the same way that hair shedding is. And so it requires a little more attention. We can wait for shedding to stop, we can wait for it to grow back, but if there's androgenetic hair loss on the scene, then starting something like minoxidyl, if appropriate, or antiandrogens, or laser or PRP or other treatments could be appropriate. But the reason those are such big deals is because those are lifelong. And so it's really important to see a dermatologist to get an accurate diagnosis. Hey, is my hair loss just telogen of fluvium? Or is my hair loss telogen afluvium and androgenetic alopecia? The treatments are slightly different. And so I think proper assessments are really important.

SPEAKER_02 13:00

And I would agree with you because I as I mentioned earlier in the podcast, and I don't know as much, and maybe in Canada if you feel like this is as common, but definitely I feel like here in the States, you know, when I have patients come in, they're like, oh, I didn't even know you treated hair loss. Like they're surprised as a dermatologist that this is something we specialize in. And some people may have gone just to talk with somebody at their salon or they have a tricologist or somebody else that they've chosen to see or talk with maybe their family doctor first, which makes sense to start there potentially. But it's amazing how many people delay coming in to get an accurate diagnosis as well. Do you feel like that's similar where you're at, or are people pretty astute in coming in to see Durham for hair loss?

Minoxidil Nuance And Lifelong Therapy

SPEAKER_01 13:38

You know, I think delays are common. I think that intuitively we've been seeing this stuff on the top of our heads for however long we've been living, and we feel we must know about this, we must understand this. And, you know, a couple of keystrokes into Google or Reddit, and you feel like, okay, I got I got the gist of it. And so you feel that, you know, what's this person gonna tell me any differently? They're just gonna, they're just gonna sell me something. I don't want to go. And so I think people are really surprised that, you know, there's a whole science behind hair that's increasingly researched and increasingly studied. And uh I think that's really exciting because, you know, there's a there's a body of literature that that guides us in some of these decisions. And, you know, to follow up on one of the points you made earlier, what what recommendations do we have to patients going through a shed? You know, I think the first thing I say to patients is it's okay to it's okay to be upset. It's okay to have every emotion in the books. It's okay to be upset and angry and happy and sad and joyous, and whatever it comes is okay. And the second thing that's okay from my perspective is to do with your hair what feels right. I think if you want to wash your hair every day, fantastic, go for it. If it really bothers you and you find when I do this, it just is really emotional, then don't. But you're not making your hair worse by shampooing every day. The hair that's going to come out is the hair that's going to come out. And so if you want to take it out slowly day by day, shower or shampoo every day. If you want to do a once a week thing where you just deal with the emotional impact once a week, then do it once a week and you're going to have a lot of hair coming out that day. But it's your hair. So wash it how you want, style it how you want. A lot of people will say, you know what, I was told, don't color it, don't cut it, don't heat it, don't. And my feeling is, you know, what's happened has happened. Your hair already got the message what to do a month ago or two months ago. It's your hair. What feels right, do it. If you color it, you're going to have colored hair that's shed. If you heat it, you're going to have heated hair that's broken and shed. But, you know, I think what's important is really for patients to have that little ounce of control. If I want to cut it, I'm cutting it. If I want to color it, I'm coloring it. You're not doing any harm by doing this.

Natural Options And Evidence Limits

SPEAKER_02 16:02

Love that because, you know, the emotional tool and the anxiety that hair loss creates and then the vicious cycle of how that impacts, you know, hair loss going forward. You know, I fullheartedly believe everything you just said because it gives patients a little bit of that sense of balance. Or, you know, in fact, I think it could help them dealing with their hair loss. If they can still color their hair and they're not, you know, terrified by the gray coming in in addition to the thinning, you know, at least we can give them something, which I think can help the emotional burden of it and maybe even potentially help them cope with it. And I always tell them if you can keep those anxiety and stress levels down, not only does it help obviously potentially hair to regrow and normalize cortisol levels and kind of help the body and the immune system and inflammation, but it can help, you know, other health aspects too. So I fullheartedly agree with what you say. And I think that is a bit of a myth. I love that you kind of did that myth busting that people are afraid to wash their hair. They're afraid of certain things because they do think they're making it worse. And you're right, the hairs that's gonna fall up, it's gonna fall out. It's just are you helping it along or letting it kind of do it, you know, sort of on its own in that way? But yeah, you got to give patients that sense of control. It can help them, I think, through this journey of dealing with hair loss. And you you mentioned the monoxidal too, obviously, for the androgenetic. Do you ever recommend it if you think they're more of a chronic shed type, you know, phase two, if they're on a GLP1? Do you feel there's benefit there if they are more in the chronic, or do you feel like if they're truly chronic, they're more than androgenetic picture?

PRP, Exosomes, And Second-Line Tools

Final Takeaways And Future Research

SPEAKER_01 17:24

So I think these are really important questions because um I think the thing that people often forget is that many of these GLP1 agonists are really required lifelong to maintain your weight. And so they're not treatments that you can go on for six months, get down to the weight you want, and then stop. Because we know from studies that generally the patient rebounds to the weight they were at. And so if a patient is shedding and shedding and shedding and they've they've been on a stable weight and they're still shedding, absolutely my very first thought is I wonder if this patient is developing some androgenetic hair loss. Maybe they're not truly a chronic telogen effluvium, maybe they're developing some genetic hair loss. And so I'll examine the scalf carefully, I'll look for the miniaturization. And if there's any uncertainty, I might even consider a biopsy. Because that really changes the treatment plan from being, we have time to wait, we can maybe, you know, just see what happens to, you know, maybe getting on a solid treatment plan is the way to go. But the reason I'm always hesitant about minoxidil, unless I'm sure, is that for androgenetic alopecia, monoxidal is lifelong. And sometimes what happens with chronic shedding is you start the monoxidal with the feeling, let's see if it stops your shedding. And if we want to stop, we can stop anytime. Because for shedding, the rules are you don't have to use it lifelong. You just use it however long you want. But sometimes in those people that you put monoxidil on, if they are evolving to androgenetic alopecia, what happens when you stop the minoxidil is their scalp says, Why did you stop the minoxidil? Didn't you know I have androgenetic alopecia? And so what happens is you get a reduction in shedding in that patient. And then when you stop the monoxidyl, the shedding goes back up. And the patient says, Wait, what's happening? Well, what's happening is you've declared that the patient in front of you has androgenetic hair loss. So they're tricky conversations, and I think they really require that kind of dialogue with the practitioner.

SPEAKER_02 19:38

Yeah, really important. I always, you know, I tell my patients, you know, those those hair follicles that like the monoxidal, it's kind of like they're fixed. They're a little addicted to it. And if they're the ones that need it, you pull that away. I mean, they just kind of, you know, those are the ones that are come out. But I like it is, you know, kind of a conversation with the patient. You know, do we do a biopsy? Do we investigate further? You know, if we do attempt this monoxidal, if you know we stop. You know, we we expect, you know, potentially if you're the androgen, it's gonna revert back, you know, to your old pattern where you know those hair follicles that needed it, they're not getting that fixed, they're definitely gonna show you that for sure clinically. And that is a hard conversation because it is hard to wait, you know. I think too, when somebody is telogen of fluvium for patients, it's hard where they feel like they might be limited in treatment options, but there are a lot of other you know things out there that are buzzy about treatment options too. So I was gonna have you touch a little bit upon because I get patients that definitely, you know, there's still this concept that natural is always better, right? And you know, in our area, people come in, they're like, well, what about rosemary oil? What about pumpkin seed supplements? I read there was a study here that showed, you know, that doing the rosemary oil could be beneficial. And so I was curious to see how you kind of approach that and if you ever recommend that for patients that have hair loss associated with GLP1s.

SPEAKER_01 20:49

Yeah, certainly they are interesting topics that really we we don't know enough about to recommend them, you know, wholeheartedly. But um we don't have any good data on how to treat hair loss associated with GLP1s. We figure that it, if it is androgenetic hair loss, that you just follow the same rules and protocols that you'd use for androgenetic hair loss. Um, and when it comes to rosemary for androgenetic hair loss, the thing I always tell my patients is I know you mentioned that study. I'm so glad you did, but did you know that was twice a day, that oil? So it wasn't just a drop of rosemary in your shampoo that you use once a week. It wasn't just rosemary that you pick up it when you remember it once a month or once every two months. It was twice a day. And, you know, rosemary can cause itching. All the essential oils can cause itching. They can sometimes be greasy, they can sometimes be challenging. And so, you know, they are options for patients that say, I don't want monoxidyl, I don't want laser, I don't want antiandrogens, I don't want anything but something that came naturally. I'm okay with it. I fully support my patient that way. Um, and for the pumpkin seed oil, you know, I think that it's it's on the list. It's certainly not on the list as a first line or second line option. I think these are really third line options. And so I say to my patients, I kind of imagine it like a toolbox. When you open the toolbox, you've got the first line agents at the top. You've got the monoxidal at the top. If you want to find the rosemary and the pumpkin seed oil, you've got to dig deep down. And it's just a reminder that we really don't fully understand how well those work in the big picture. If you use pumpkin seed oil for six months, maybe just maybe you get a benefit based on the studies. But if you use pumpkin seed oil for 24 years, are you still benefiting at year 24? We don't know. And so there's a lot of unknowns. And I think what I'm excited about for the next few years is as we understand more about GLP-related hair loss, how do we treat it? And what stories are out there? And I think that's so important for your clinician listeners is not to not to get too wrapped up in GLPs, causelogen ifluvium. Once the weight stabilizes, hair grows back. We know now that that's not correct. And so be open to listening, be open to observing. And if you're finding these different patterns, you know, consider sharing it. I have patients, for example, that say, Do you know I'm absolutely certain that I developed hair loss a week after my GLP one started? And you'll say to them, you know, that doesn't follow the rules. It's supposed to be two months. No, I'm absolutely confident it was one week. And I think there's a lot of these stories out there of patients that have all different patterns. And I think as a dermatology community, we now have to share these stories to understand it better, including how to treat it.

SPEAKER_02 23:49

And I was curious too, just to kind of wrap up in the last few minutes, we have what about you know some of these regenerative techniques, you know, that people talk about like PRP or exosomes? Do you feel like they have any role? Or do you really feel like it's really foresee that GLP1 associated hair loss episode we have know of now that's more androgenetic in nature? Or is that something that you've attempted in patients that are more of a chronic shed?

SPEAKER_01 24:13

Yeah, you know, most of our patients with chronic shedding and evolution to androgenetic alopecia, we're, you know, we're starting monoxidal, topical or oral, and in some cases anti-androgens as our more standard protocol with androgenetic hair loss, sometimes laser. You know, we don't know enough about how PRP and exosomes fit in here yet. Uh, I certainly view those as second line. Um, and so I really feel kind of a sense of following protocol when these patients are having hair loss because I want to try to put the best odds on in their favor. And so I feel right now that maybe just maybe some of those treatments like monoxidyl might have better odds for them than other treatments, but they're certainly on the list. And I think if someone says, I don't want monoxidal, I don't want antiandrogens, I did laser, it did nothing, then we have things like PRP on the list. And I think it's very reasonable to pursue that. The thing that everybody with androgenetic hair loss needs to remember is that's PRP lifelong.

unknown 25:22

Yeah.

SPEAKER_02 25:23

Yeah, I think that chronicity thing is is the scary part, you know, because I, you know, we're used to sometimes with certain medications, they can cause a potential shed, and that can stabilize, right? With certain medications. If this is going to be a longer process or potentially that evolution, as you mentioned, into androgenetic alopecia, you know, it is hard. We don't know who those people are going to be. But I think you really summarized it well, where you're like, hey, be open to it, monitor these patients, you know, explain to patients, you know, around 15%, you know, actually will experience hair loss when on these medications. And although we don't know how to prevent it yet, we can definitely be vigilant because, you know, I think the data is definitely sound and showing the benefit it can have for some of our patients. And I hope they're not deterred by the possibility of potentially having hair loss. Jeff, any other final comments or things that you would share about GLP1s and hair loss as well for our listeners?

SPEAKER_01 26:11

I think you said it that, you know, these drugs are really revolutionary for so many things. And they're helping with weight loss, they're helping with insulin resistance, they're affecting people's, you know, cardiovascular risk and they're improving quality of life. And so there's so many good things about these medications. And so it's just these delicate conversations about risks and benefits and thinking about these and you know, teaming up with your practitioner and saying, hey, this is what's happening. What do we do? And, you know, knowing that that there's options out there and having those careful discussions. But uh the final message is stay tuned. We're gonna be learning a whole lot, and our conversation next year is gonna be different than this year. So stay tuned.

SPEAKER_02 26:52

We'll have to have you back on to give us the updates because I know there's a lot of people just waiting to find out where this is headed. And who knows what doors it may open, you know, up for just hair loss in general, because obviously many different types, and we still have room for improvement in treating it and dermatology and helping patients out. So thanks so much for coming on the podcast, Jeff. It was great to have you here today.

SPEAKER_01 27:11

Oh, thanks so much.

SPEAKER_02 27:12

Of course. And stay tuned for the next episode of Dermot Trotter. Don't swear about skincare.

Outro And Listener Actions

SPEAKER_00 27:18

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